Utilization review nurse serp_jobs.h1.location_city

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

REMOTE ROLE : 4-6 years of clinical Occupational Therapy experience (Pediatrics) to assess and perform utilization reviews.

Position Purpose : Performs complex clinical reviews of clinical therapy services and / or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards. Applies clinical knowledge and provides recommendations to senior management team to identify ways to improve the review and execution of therapy services based on clinical reviews of service request.

Assesses and performs utilization reviews of service requests regarding complex specialty therapy services and / or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies

Manages and collaborates works with Utilization and Care Management team and healthcare providers to ensure members are receiving the appropriate care and treatment

Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement with therapy services and / or durable medical equipment for members

Provides education including developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions

Partners with leadership on opportunities to improve the review and therapy services and / or durable medical equipment outcomes to members based on standards and organizational policies

Provides feedback to leadership on opportunities to improve the review and therapy services and / or durable medical equipment outcomes to members based on standards and organizational policies

Performs other duties as assigned

Complies with all policies and standards

Education / Experience : Requires a Bachelor's degree and 4 - 6 years of related experience.

Advanced clinical knowledge of clinical therapy services and / or durable medical equipment preferred.

Strong knowledge of therapy regulations and guidelines preferred.

Strong knowledge of utilization management processes preferred.

License / Certification :

• OT - Occupational Therapist - Registered required

Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act